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#R ,� Towno Mas ee <br /> 16 Great Xeck Pvoad Xorth <br /> � UtE Mashpee, Massachusetts 02649 <br /> t <br /> Handicap Discrimination Complaint <br /> Please type or print clearly. <br /> I hereby notify the Town of Mashpee that I believe that I have been subject to unlawful discrimination <br /> against me on the basis of my physical or mental handicap on <br /> by <br /> date of alleged discrimination name of agent or agency against which this complaint is filed <br /> g <br /> The particulars of my complaint are as follows: <br /> -You may attach additional information,photographs or other evidence. <br /> I have not commenced any action, civil or criminal, based upon the grievance set forth above, except <br /> (Please specify any legal actions commenced) <br /> My legal name is <br /> My current mailing address is <br /> My telephone number is <br /> continued on reverse <br />